MACRA’s Money Effects Depend on Providers, Study Finds

Fri, May 26, 2017

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MACRA and its shift to a value-based payment model has people in the business of healthcare talking. While most of us may be thinking about the MIPS (Merit-Based Incentive Payment System) track for the Quality Payment Program, there is another option: Alternative Payment Models (APMs). An APM offers incentive payments for high quality, cost-efficient care.

Will Physician or Hospital Payment See Bigger Changes?

A team from RAND Corporation looked into the effects of APMs by using the RAND Health Care Payment and Delivery Simulation Model (PADSIM), which provides a framework for seeing how providers act in response to payment policy changes.

Here are a couple of the key findings reported in the research brief:

  • Medicare spending on physician services will be lower under MACRA. The RAND team estimates a drop somewhere between $35 billion and $106 billion.
  • There’s a wide range of possibilities when it comes to hospital payment changes. They could see an increase of $32 billion or a decrease of $250 billion.

Whether payment incentives drive changes in physician behavior will be a major factor in which direction hospital payment goes. The RAND research brief lists the examples of “working to avoid hospital readmissions or reducing use of hospital care,” and also states that having well-designed APMs is an important factor in encouraging participation.

From a financial perspective, the research indicates healthcare business models will need an update to be based around value.

Where to Learn More About APMs

You can see a list of Advanced APMs on the CMS APM site. Examples include Comprehensive Primary Care Plus (CPC+), Next Generation ACO Model, and Oncology Care Model (OCM).

To get a better idea of what CMS wants to see in an APM model, check out the Alternative Payment Model Design Toolkit.

You have to submit the quality data your Advanced APM requires, but meeting participation requirements in 2017 brings a 5 percent incentive payment in 2019. The CMS site indicates you must receive a quarter of your Part B payments through the Advanced APM or see 20 percent of your Medicare patients through the Advanced APM.

What About You?

Will you be using the APM track? What have you learned?

 

 

 

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Here’s What’s in Store for Medicare Advantage and Part D in 2018

Tue, May 23, 2017

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Medicare Advantage and Part D

Check out these bullet points for highlights from the 2018 Medicare Advantage and Part D payment and policy updates posted by CMS.

Medicare Advantage

Medicare Advantage (MA) plans, sometimes called Medicare Part C, are private plans approved by Medicare for people enrolled in Medicare. Medicare pays a fixed amount to the MA plan company, and the company provides Medicare Part A (hospital) and Part B (medical) coverage. The plans often offer Part D (prescription drug) coverage, too.

  • The expected total change in revenue is 2.95 percent for Medicare Advantage. That’s 0.45 percent for the expected average change in revenue plus 2.5 percent for coding trends. That’s a bit above the 2.75 percent total listed in the Advance Notice. It’s also worth noting that actual amounts may vary.
  • Calculation of risk scores will use encounter data for 15 percent, and Risk Adjustment Processing System (RAPS) and Medicare Fee-for-Service (FFS) diagnoses for 85 percent. The 2018 Advance Notice had proposed to continue to use 75 percent RAPS and 25 percent encounter data, but comments played a part in deciding on the final 85/15 blend. In short, operational issues led to commenters suggesting either a more limited use of encounter data or an adjuster.

Part D

As mentioned above, Part D offers drug coverage.

  • Part D benefit parameters see some changes. For instance, the deductible for the standard benefit in 2017 is $400 and in 2018 it’s $405, and the out-of-pocket threshold will change from $4,950 to $5,000.
  • Opioid overutilization criteria change in 2018. CMS posted an analysis including these changes (bullets below are direct quotes):
    • Current Opioid Overutilization Criteria:
      • Use of opioids with cumulative daily MED [morphine equivalent dose] exceeding 120 mg for at least 90 consecutive days with more than 3 prescribers and more than 3 pharmacies contributing to their opioid claims, during the most recent 12 months, excluding beneficiaries with cancer diagnoses and beneficiaries in hospice.
    • Revised Opioid Overutilization Criteria:
      • During the most recent six months:
        • Use of opioids with an average daily MED equal to or exceeding 90 mg for any duration, and
        • Received opioids from more than 3 prescribers and more than 3 pharmacies, OR from more than 5 prescribers regardless of the number of dispensing pharmacies.
      • Beneficiaries with cancer diagnoses and beneficiaries in hospice are excluded.
      • Prescribers associated with a single TIN are counted as a single prescriber.

How About You?

What do you think of the 2018 plan?

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4 Motivators for Sticking to the Coding Straight and Narrow

Mon, May 8, 2017

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Compliant coding is worth the effort!

If you ever take the “throw everything out there and see what sticks” approach to coding, it’s time to rethink that strategy. Carefully choosing the wrong codes to bring in more money is no way to code either. Next time you need inspiration to steer clear of these methods, reach for these four reasons coding correctly really is worth the effort.

1. ‘Them’s the Rules’

Choose any code set or a payer, and it likely won’t take you long to find a rule saying that you must assign a code based on what the documentation supports and what the reporting guidelines require. Simply put, a big part of being good at our chosen profession is following the rules.

For instance, if you’re looking at a close-but-not-quite procedure code, remind yourself that the Introduction to the AMA CPT® manual states, “Do not select a CPT® code that merely approximates the service provided.”

And if you find yourself considering a questionable choice and thinking, “It’s not like I’m masterminding a $50 million healthcare fraud scheme,” take a pause. Reassess to ensure your coding complies with the rules. Your career and even your finances and freedom could depend on it.

2. Face Audits Stress-Free (OK, With Less Stress)

Putting in the effort to make each claim accurate will do a lot to boost your confidence if a payer chooses you for an audit. If your services are medically necessary, the documentation supports that, and the coding matches the documentation, an audit should go fairly smoothly. You’ll know that you haven’t done anything intentionally that could put you and your team at risk.

3. Your Future Self Will Thank You

When you submit clean claims, you reduce denials which is good for at least two reasons (in addition to the audit benefits above). One is that you won’t have to go through all the time and energy required for rework and appeals. Another is that you won’t risk losing money by letting denials slide.

It also doesn’t hurt that with every little bit of research you do for one claim, you’ll reap the benefits of that research when similar cases come up in the future.

4. Get the Nickname Captain Accuracy

Doing the hard work day in and day out does get noticed. You’ll help your career and future advancement opportunities by getting a reputation for understanding complex coding rules and payer requirements. Never forget how important you are to your organization’s financial health and compliance.

How About You?

Do you ever have those moments where you wonder if keeping up with coding rules is worth it? What do you do to power through? How do you make keeping up with rule changes easier?

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7 Questions ID the Online Medical Code Search That’s Best for You

Fri, May 5, 2017

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When I first entered the coding world, printed coding manuals were the home of medical codes. Fast forward to today, and there are a lot of options if you prefer to find a code online instead. Here are some ideas on what to look for when choosing an online code search (don’t miss #6).

1. Does It Have the Code Sets You Need?

Let’s start with the obvious. Useful medical coding software (sometimes called encoder software for medical coding) will combine all the code sets you need.

For instance (shameless plug alert!) SuperCoder Code Search lets you search CPT®, HCPCS, ICD-10-CM, and ICD-9-CM. But if you want access to code sets used exclusively by outpatient or inpatient facilities, one of SuperCoder’s facility coding solutions would be a better fit for you.

2. Can You Search Terms That Makes Sense to You?

To get to the right code fast, a robust search engine is a must. Will the search box get you where you want to go if you enter a code, code range, keyword, string of keywords, or abbreviations?

3. Can You Narrow and Sort the Search Results?

A long list of results can slow you down. Check for the options your medical encoder offers for narrowing search results. For example, you may be able to limit the source of your results to index entries, index tables, specific code sets, or the online code search provider’s own search database.

When you’re searching a term that has a lot of results, being able to sort the results is also helpful. Ask if you can sort by code order and by relevance to the search terms.

4. Does It Provide Extras to Improve Accuracy?

Bare bones code search tools have their place, but they don’t do a lot to help ensure you’ve got the right code. Make sure your online code search is up to whatever job you need it to do.

For instance, having official code descriptors is essential, but you won’t be able to understand proper use of the codes if you don’t have the official guidelines, too. Sometimes even that isn’t enough, so look at whether the resource provides lay terms to help you match what you see in provider documentation to the correct code. Illustrations are another feature that can help you get a better understanding of the procedure the code describes.

5. Can You Create Personal and Group Notes?

Confirm that you can save a personal note with a code. If you’ll have more than one user, ask if you can share notes so it’s easier for the team to follow tips and internal rules consistently.

6. Can You Trust the Accuracy of the Results?

Details matter in coding. Every digit must be correct. And don’t get me started on the trouble the addition of “(s)” to a code descriptor can cause. Get your online code search from a company you can rely on to have all the particulars in place. Ask how and when updates occur. And choose a company that you know will be responsive to feedback, including suggestions for improvements.

7. What Else Should I Know About This Code Search?

Can you get CEUs with your subscription? Can you see both code details and range pages, and select the type of page you want to see as default? Ask what makes the online code search tool you’re considering unique.

What About You?

How would you describe your ideal medical billing and coding software?

 

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Are You an Anatomy Ace? This Chemo Quiz Will Tell

Thu, May 4, 2017

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learning anatomy to code better

Let’s mix things up today with a little test. An article in Oncology & Hematology Coding Alert about intracavitary chemotherapy made me think about the importance of knowing anatomy when you need to pick an appropriate code. We often think about anatomy with ICD-10-CM codes, but it’s important for CPT® codes, too.

That’s the inspiration behind this pop quiz. See if you can match the anatomic description to the correct chemotherapy administration CPT® code.

Here Are Your Code Options

A. 51720 (Bladder instillation of anticarcinogenic agent …)

B. 96440 (Chemotherapy administration into pleural cavity …)

C. 96446 (Chemotherapy administration into the peritoneal cavity …)

D. 96450 (Chemotherapy administration, into CNS (e.g., intrathecal) …)

E. 96401 (Chemotherapy administration, subcutaneous …)

F. 96413 (Chemotherapy administration, intravenous …)

Match the Codes Above to the Relevant Anatomy Defined Below

__ 1. The central nervous system, including the area inside the membrane covering the spinal canal

__ 2. A closed space between the two layers of the lung

__ 3. Related to a vein, a tube that carries blood toward the heart

__ 4. An empty space in the layer of connective tissue lining the abdominal cavity

__ 5. A hollow muscular organ that stores urine prior to urination

__ 6. The area under the skin

Check Your Answers (No Peeking!)

  1. D. Intrathecal chemotherapy administration described by 96450 requires spinal puncture, which involves inserting a needle into the spinal canal to reach the cerebral spinal fluid.
  2. B. Chemotherapy administration represented by 96440 involves using thoracentesis (inserting a chest tube) to get the chemotherapy drug into the area between the lung and the lung lining. This procedure can help control cancerous fluid accumulations called malignant pleural effusions.
  3. F. Chemotherapy administration into a vein (IV) reported with 96413 is well known to coders who work with oncologists who provide chemo infusions. IV admin gets the medication into the bloodstream, which moves the meds through the body.
  4. C. Code 96446 represents administration into the cavity surrounding the organs in the abdomen. The provider may have the patient change positions during treatment to help the medication move within the cavity.
  5. A. Administration into the urinary bladder falls under 51720. Terms you may see for the agents involved include Bacille Calmette-Guerin (BCG) and Mutamycin.
  6. E. A subcutaneous injection (sub-q) uses a short needle that reaches between the skin and muscle. The abbreviated code descriptor shown for 96401 above leaves out that the official descriptor also includes intramuscular administration. Intramuscular administration goes through the skin and into the muscle layer. Chemotherapy chemicals are often too harsh to be delivered directly into muscle.

What About You?

How did you do? How did you learn the anatomy important to your specialty?

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Secrets to Subsequent Hospital E/M Coding Success

Tue, May 2, 2017

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coding for hospital visits

Curious how your use of subsequent hospital visit codes compares to reporting by other practices? Palmetto was curious, too. The Part B MAC took part in developing a Comparative Billing Report (CBR) looking at 99231-99233 billing and payment patterns in 2015 for internal medicine providers. Motivation? Those codes see about a billion dollars in improper Medicare payments each year. Keep your hospital visit reporting on the up and up by getting to know the codes and common problem areas.

Did the Case Really Earn 99233?

One of the areas the CBR looked at is the percentage of total services reported as high-level code 99233. Nationally, the rate was 32 percent, but percentages varied state to state. For instance, Wyoming averaged 20 percent, but Arizona averaged 53 percent!

We can’t know from these numbers whether anyone is coding inappropriately. It’s possible the patient population in one area consistently requires higher level services than the patient population in another area. What you can do is look at your own usage patterns to see if you vary widely from your state. And, of course, make sure you’re coding each case based on the documentation available, with special attention to whether the medical necessity of the case supports the code level assigned.

Here are the elements in each code:

  • Elements applicable to all three codes
    • Subsequent hospital E/M
    • Reported per day
  • 99231
    • 2 of these 3 key components:
      • Problem focused interval history
      • Problem focused exam
      • Straightforward or low complexity medical decision making (MDM)
    • Patient is stable, recovering, or improving
    • 15 minutes at bedside and on floor/unit typical
  • 99232
    • 2 of these 3 key components:
      • Expanded problem focused interval history
      • Expanded problem focused exam
      • Moderate complexity MDM
    • Patient is not responding adequately or has a minor complication
    • 25 minutes at bedside and on floor/unit typical
  • 99233
    • 2 of these 3 key components:
      • Detailed interval history
      • Detailed exam
      • High complexity MDM
    • Patient is not stable, has a significant complication, or has a significant new problem
    • 35 minutes at bedside and on floor/unit typical

Keep the Documentation Focus on Quality Not Quantity

Based on problems commonly seen, Palmetto staff offered some areas to watch to ensure your 99231-99233 documentation is up to snuff:

  • Easier to spot: Incomplete/illegible notes, lack of documentation, unclear dates of service, problems with provider signature
  • Tougher to spot: Lack of medical necessity — base code choice on complexity supported by the documentation, not just the amount of documentation.

Bonus: When to Report Subsequent Code for Initial Visit

Let’s take your hospital visit know-how up another notch by going over an interesting oddity of Medicare reporting. When Medicare stopped accepting consultation E/M codes, it created some problems for reporting initial hospital services that didn’t meet the requirements for reporting an initial hospital visit code. Medicare’s solution is to allow you to report a subsequent hospital care code that describes the work and medical necessity requirements even when it’s the provider’s first inpatient service during the stay. You’ll find the rule in Medicare Claims Processing Manual, Chapter 12, Section 30.6.10.

What About You?

Do you have tips for choosing between the different code levels and getting the documentation you need?

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4 Tips Take Your MOCA Coding From ‘Meh’ to Marvelous

Fri, Apr 28, 2017

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MOCA therapy for varicose veins

Move over, unlisted vascular surgery code 37799! That’s what mechanochemical ablation (MOCA) codes 36473 and +36474 said when they became reportable CPT® codes on Jan. 1, 2017. Give your use of these new endovenous ablation codes a check-up with the four pointers below.

1. Read the Descriptors All the Way Through

Reading the descriptor is a pretty obvious first tip, but there’s a reason for that. Here are the descriptors:

  • 36473 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated)
  • +36474 (… subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)).

Just look at some of the fun facts you can learn:

  • The codes apply to percutaneous services in an extremity
  • Code 36473 is for the first vein, and +36474 is for one or more subsequent veins treated in that extremity
  • The codes include all imaging guidance and monitoring.

2. Use the Code Only for the Intended Tech

What it is: These codes apply to “concomitant use of an intraluminal device that mechanically disrupts/abrades the venous intima and infusion of a physician-specified medication in the target vein(s),” according to CPT® guidelines.

That’s a mouthful. A device brand name you’ll see tied to MOCA is ClariVein®IC. In the procedure, the provider administers local anesthesia and inserts an infusion catheter with a special wire tip into the incompetent (varicose) vein. Remember that any imaging guidance used is covered under the surgical code. She attaches the catheter to a motor drive unit. The wire tip rotates quickly inside the vein and delivers the medicine the provider chooses.

What it is NOT: “Sclerosant injection by either needle or catheter followed by a compression technique is not mechanochemical vein ablation,” the CPT® guidelines state. Use 37799 (Unlisted procedure, vascular surgery) for catheter injection of a sclerosant without the accompanying mechanical disruption of the vein intima, which is the inner layer.

3. Be Sure You Get the POS Right

The fees vary considerably for these surgery codes depending on whether you’re reporting physician work in a facility or nonfacility setting. As the CPT® guidelines explain, supplies and equipment required are included in payment when performed in the office setting.

For 36473, the Medicare Physician Fee Schedule (MPFS)  in Q2 of 2017 shows these national rates (meaning they’re unadjusted for geography):

  • Facility rate $179.80
  • Nonfacility rate $1,522.40.

That’s a whopping $1,342.60 difference that you don’t want to lose or have to repay because of a simple place of service (POS) mistake.

The fee difference for +36474 isn’t quite as exciting, but getting POS wrong would add up fast:

  • Facility rate $90.08
  • Nonfacility rate $278.86.

4. Think Twice Before Reporting E/M

Code 36473 has a global period of 000. Here’s the official definition for that indicator from Medicare, which makes it clear that an E/M on the same date usually isn’t payable: Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

As an add-on code, +36474 has a global period of ZZZ, which means: The code is related to another service and is always included in the global period of the other service.

How About You?

Code 36473 has an MUE of 1 in Q2 2017. Has that caused issues for you?

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Update Vaccine Codes Just in January? 4 Changes Prove That’s a Mistake

Tue, Apr 25, 2017

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July 2017 vaccination coding updates

On Friday, SuperCoder blog covered molecular pathology CPT® code updates effective July 1. Today, let’s look at what’s coming our way in July for vaccines. Because why should January 1 have all the update fun?

Schedule: The codes we’re discussing here were published on the AMA website on Jan. 1, 2017. They’re effective July 1, 2017, and will be in the printed CPT® 2018 manual.

Adopt 90587 for Dengue

July 1 brings one new code: 90587 (Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use).

Dengue is a mosquito-borne illness typically associated with tropical and subtropical areas. Patients suffer from high fever, rash, and muscle and joint pain that has earned the disease the descriptive nickname “breakbone fever.” Treatment is often limited to hydration and pain medication.

Tip: You’ll find a lightning bolt symbol next to new code 90587. The CPT® Editorial Panel allows publication of new vaccine product codes before FDA approval. A lightning bolt symbol by the code lets you know FDA approval is pending.

Make Changes to 2 Meningococcal Vax Codes

There will be a minor change to use the term MenB-4C in a revised descriptor for 90620. The revised descriptor looks like this: Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use.

MenB-4C is the complete scientific abbreviation assigned by the Advisory Committee on Immunization Practices (ACIP). The CPT® Editorial Panel approved using these abbreviations in vaccine code descriptors in the May 2014 meeting.

You’ll see a similar ACIP abbreviation update in a revised descriptor for 90621: Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB-FHbp), 2 or 3 dose schedule, for intramuscular use. Also note the reference to the “2 or 3 dose schedule,” which differs from the reference to only a three-dose schedule in the 90621 descriptor published in the 2017 printed manual.

Meningococcal diseases can affect the brain and spinal cord, and cause bloodstream infections. Antibiotics can treat infected patients.

Update Dose Schedule for HPV Code 90651

On July 1, a new dose schedule enters the descriptor for 90651. Here is the revised descriptor: Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use.

Instead of referencing only a three-dose schedule, the descriptor effective July 1 includes the newly approved two-dose schedule.

HPV vaccines protect against certain types of HPV, helping with prevention of genital warts and some cancers, like cervical and anal cancers.

How About You?

Were you aware that to streamline reporting of immunizations, Category I vaccine codes have July 1 and January 1 early release dates? In urgent situations, a code may even be published outside of that schedule.

 

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Review What’s New for Tier 2 MoPath Codes in July 2017

Fri, Apr 21, 2017

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july 2017

All of you who have never read the descriptor for a tier 2 molecular pathology procedure code, go check out 81400-81408. Then tip your hat to MoPath coders because those code descriptors are lo-o-o-o-ng.

To add to the fun, CPT® releases descriptor changes for these codes more than once a year. The descriptor changes effective July 1, 2017, take four pages to list, so in this post we’ll look only at additions. You can find the complete list under Downloads on AMA’s CPT® Molecular Pathology Tier 2 Codes site.

These changes were posted to the AMA site Jan. 1, 2017; are effective July 1, 2017; and will be published in the CPT® 2018 manual.

Look for New Tests Listed Under 81405

Before starting its long list of tests, the descriptor for 81405 begins with “Molecular pathology procedure, Level 6 (e.g., analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally targeted cytogenomic array analysis).”

(Would be nice if 81405 was for level 5 and not level 6, right? But you can’t have everything.)

Effective July 1, insert these additions to the descriptor for 81405:

  • CPOX (coproporphyrinogen oxidase) (e.g., hereditary coproporphyria), full gene sequence
  • CTRC (chymotrypsin C) (e.g., hereditary pancreatitis), full gene sequence
  • PKLR (pyruvate kinase, liver and RBC) (e.g., pyruvate kinase deficiency), full gene sequence.

Code 81406 Adds 2, Too

The descriptor for level 7 code 81406 begins this way: “Molecular pathology procedure, Level 7 (e.g., analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons, cytogenomic array analysis for neoplasia).”

  • HMBS (hydroxymethylbilane synthase) (e.g., acute intermittent porphyria), full gene sequence
  • PPOX (protoporphyrinogen oxidase) (e.g., variegate porphyria), full gene sequence.

How About You?

Do you report MoPath tests? What tips would you offer someone just starting out in the specialty?

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2 Costly Hip Coding Mistakes Corrected

Tue, Apr 18, 2017

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hip coding tips

With all the hippity hoppity talk this time of year, I have coding for hips on the brain. Might as well go with it and look into some hip coding tips!

1. Watch for Mod 22 Opportunities With Congenital Cases

If your surgeon performs hip replacement surgery for a developmental or congenital hip dislocation, there’s a decent chance the procedure required enough extra time and work to merit the use of modifier 22 (Increased procedural services).

Don’t assume: The diagnosis alone doesn’t support use of this pay-enhancing modifier. Details of the work and time required beyond the normal range is key to convincing the payer.

In clinical documentation improvement training, inform surgeons about the reimbursement benefits of including a separate paragraph in the op note describing any extra work required for an individual case. Documentation that gives the reviewer clear information will go a long way. For instance, if an underdeveloped acetabulum requires advanced techniques and complex implants during the surgery, the op note should spell that out, identifying how the current case differs from a typical one.

2. Know Your Payer’s Edits and Expectations

You may find that different payers have different rules about which codes may be reported together. Keeping tabs on individual payer edits can be worth the effort if you discover you’ve been ignoring a reportable code.

Example 1: Suppose a patient previously underwent open reduction with internal fixation for a femoral neck fracture. Now, due to nonunion, the patient requires hip hemiarthroplasty with adductor tenotomy and hardware removal. The relevant codes are:

  • 27125 (Hemiarthroplasty, hip, partial (e.g., femoral stem prosthesis, bipolar arthroplasty))
  • 27001 (Tenotomy, adductor of hip, open)
  • 20680 (Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)).

Medicare Correct Coding Initiative (CCI) edits prevent payment for 20680 when reported with 27125. But other payers may not apply that edit. You don’t want to miss legitimate opportunities to receive payment for both codes.

Example 2: For a patient who had a subtrochanteric osteotomy in the past and has another as part of total hip arthroplasty, you should report 27132 (Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft). Should you also report osteotomy code 27165 (Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast)? CCI doesn’t bundle the two codes, but some payers may not pay for both on the same claim. Knowing payer rules will help your practice know what to expect as reimbursement.

Bonus tip: When you do report more than one code, know your payer’s rule for modifier 51 (Multiple procedures). Medicare asks you not to use modifier 51, but other payers may require you to use the modifier on codes for additional procedures when you report more than one procedure for a patient on the same date.

How About You?

Have any hip coding success stories to share?

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